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Evolutions of Psychoanalysis
In chronological order:
“Cathartic Cure” (Breuer)
From 1881-1882, physician Josef Breuer treated a patient named Bertha Pappenheim by asking
her to make up stories about her hysterical symptoms. When she did so, the symptoms dissipated or temporarily vanished. She remained ill, but the two of them evolved what she called a
“talking cure” that interested Freud. His claim that this sort of abreactive therapy, a forerunner
of his psychoanalytic method, was “cathartic” for healing childhood traumas appeared in Breuer
and Freud’s Studies in Hysteria (1895) a few years after Janet had used cathartic and interpretive
methods successfully with his patients at Le Havre and the Salpetriere in France. Breuer’s original case notes contain no references to catharsis, interpretation, or childhood traumas.
Freudian Psychoanalysis
Like its name (derived from the “psychological analysis” of Pierre Janet), Freudian psychoanalysis integrated ideas and practices from many different types of theory and therapy. Its primary
goal is to strengthen the ego (conscious self) to manage the id (the cauldron of sexual and aggressive instincts boiling in the unconscious) while maintaining good relations with the superego
(the internalized conscience and social norms) and with reality. This is accomplished through
work with dreams and through interpretive analysis of the transference, the past emotions and
wounds the patient projects onto the analyst. The basic fuel of the instincts and therefore of psychic life Freud called libido: inherently erotic energy emanating from the id.
Ego Psychology (Anna Freud, Hartmann, Kris, Erikson, Rapaport)
Around the time Freud died, clinical emphasis was shifting from the unconscious and the id and
the “instincts and their vicissitudes” to the ego: its defenses, its strengths, and its conflict-free
ego sphere (Hartmann) of healthy operations relatively independent of the id’s blind drives. Ego
psychologists posit an undetected hydraulic system that neutralizes the libido free of its sexuality
so its energies can operate the ego. (For C. G. Jung, the libido was already neutral.) Ego psychology is the successor of Freudian psychoanalysis, and has been vigorously defended as such.
Object Relations (Fairbairn, Guntrip, Winnicott)
By object Freud had meant the target of an instinct, whether sexual or aggressive. Melanie Klein
extended this concept by insisting that infants take inside themselves a more or less permanent
mental image of the parent object. In the 1940s, W. D. R. Fairbairn extended this further by attributing mental health and illness not to managed or blocked drives, as in Freud’s model, but in
terms of satisfying or frustrating human relationships. With his concept of dynamic structures he
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also did away with the idea that psychic energy, unobservable to begin with, was worth talking
about apart from ego structures, which were already charged with their own. This gave psychoanalysis a soundly relational footing and inaugurated the dismantling of classical drive theory.
Self Psychology (Kohut, Patrick, Ornstein and Ornstein)
For object relations theorists, objects create psychic structure by being internalized early on.
That is their primary purpose. For Kohut, however, our need for caring objects is lifelong. Objects vital to the well-being of a person he called selfobjects, thereby bridging the classical gap
between inner and outer, psychic and relational. Kohut also designated a separate developmental
line for narcissism (a neutral term for self-love) apart from the traditional Freudian line of psychosexual development (oral, anal, latency, genital). Serious psychopathology derives not from
repressions, but from deficits: missing gaps in the self left by insufficient transmuting internalizations (nourishment and structure derived from selfobjects). Healing requires filling in these
gaps through interactions with the selfobject therapist. Health means an improvement in the
quality of selfobject relationships, not their abandonment.
Intersubjectivity (Stolorow, Atwood, Ogden, Benjamin)
Rather than being innate, inner structures cannot be understood outside of their relational context: the changing intersubjective field between psyches. Personality in this view is less a thing
than a flowing series of structures of experiencing, some more long-lasting than others. A central human motive is to maintain those structures (in contrast to discharging drives or managing
inner objects). Development resides in the gradual structuralization of experience—its integration and differentiation--via helpful selfobjects. Health: optimal structuralization that balances
current structure with openness to new experiences.
Relational Psychoanalysis
Less a separate perspective than a way of practicing the clinical applications of intersubjectivity
theory. The primary premise is that psychic structure derives from our relations with other people. Relational therapy remains “experience-near” and focused on the field of shifting subjectivities between therapist and patient. A key focus is on what occurs on the boundary between the
patient and therapist, both of whom contribute consciously and unconsciously to the interactive
field that embraces both.
Note: Adler’s Individual Therapy and Jung’s Complex Psychology both evolved from their experiences with psychoanalysis as Freud designed it, but ordinarily neither are considered varieties of it. Along with psychoanalysis, they are contained within the larger umbrella of depth psychology, the field that explores the interactions between conscious and unconscious.